Favorite Quick-reference On-shift Resources:
This website offers a quick guide to differentials and treatment plans for common complaints and is very user-friendly. Sometimes the recommendations are a bit out-of-date, so always check with your senior EM resident or ED attending if there are questions.
This blog is a great resource for common ED presentations and has many additional resources for a deeper dive.
Great for those common pediatrics cases that we sometimes run into at HMC and UW.
Resources for Understanding Common ED Presentations
We encourage you to familiarize yourself with our OCCAM ED reference kit for common presentations and protocols.
There is a robust UW Content Library on OCCAM that has many recommended protocols and treatment plans for patients. It has a helpful search tool.
For UW Faculty lectures regarding common presentations, we welcome you to explore this website developed for our clerkship.
ALiEM (Academic Life in Emergency Medicine)
This is a great free resource for understanding common ED presentations in the form of a course designed for practicing in the emergency department.
For the deepest dive, the UW library offers free access to two frequently used textbooks - Tintinalli’s Emergency Medicine and Rosen’s
Have some spare time? Check out these great free EM Podcasts:
- EMBasic
- Core EM – Emergency Medicine Podcast
- Emergency Medicine Cases
SPECIAL PATIENT POPULATIONS
Substance Use Disorders – HMC and UWMC
Many of our patients have substance use disorders. We have protocols in place to treat many of these substance use disorders and are particularly interested in connecting these patients with resources. Both of our EDs are staffed with social workers 24/7 who can provide assistance to patients with things like detox facilities, shelter resources, and medical respite. HMC also has a robust Office-Based Opioid Treatment (OBOT) clinic and you can make appointments for your patients through the back desk. Ask your senior how to make this happen. For more information on OBOT, you can visit their website.
Please feel empowered to treat patients for their substance use disorders if they are seeking treatment. Search on OCCAM for ED Initiated Buprenorphine for more information about appropriate treatments for patients who are struggling with opioid withdrawal or are interested in starting treatment for opioid use disorder.
Sexual Assault Nurse Examiners - HMC
Harborview has 24/7 access to forensic Sexual Assault Nurse Examiners. This resource is for patients who present to the emergency department who may have experienced a sexual assault. Ask the ED social workers and your attending for help with this resource as needed.
Psych Emergency Services (PES) - HMC
The HMC ED is fortunate to have 24/7 psychiatrists on call for patients experiencing psychiatric emergencies. If your patient is experiencing a psychiatric emergency or mental health crisis such as suicidality, you can talk with the psychiatry attending on call by calling through your ED work phone. The PES is a secure locked 10-bed unit that is capable of caring for these patients and arranging for legal detainment (DCR referral) if needed. If your patient is “medically cleared” and ready to be transferred to the PES, you can discuss the patient with the psychiatry attending by calling and requesting a “Doc to Doc”.
The PES is capable of caring for chronic illnesses and distributing daily home medications, but they are not a medical unit. If your patient needs admission for a medical reason, they should be admitted to the appropriate inpatient service and psychiatry can be consulted as needed. The PES will ask for a medical reconciliation and if the patient has any therapies that you are prescribing (ie antibiotics, Suboxone, insulin, etc) then you will need to provide them with the appropriate medications, dosing, route, and duration.
King County Jail - HMC
Harborview Medical Center is the only hospital that provides care to inmates at the King County Jail (KCJ). We are responsible for these patients and they should be treated with the same dignity and care as non-incarcerated patients. These patients have the right to confidentiality of their health information. If you need to examine your patient and they are in restraints, you simply need to ask the officer to modify their restraints for your exam. The officer also should not be in close enough proximity of your patient to overhear protected health information, and you are encouraged to remind the officer of this if needed. If you find that you need guidance navigating these encounters, please discuss with your attending on shift.
If you are discharging a patient back to KCJ, before they can leave the department your note must be finished and signed. This note is printed out by nursing and placed in a confidential envelope for the KCJ clinic staff to review. Any medications that you want your patient to take, including commonly used over-the-counter items such as acetaminophen or ibuprofen, must be included as printed prescriptions that will go with the patient. Please remember to sign these prescriptions. You can prescribe Suboxone and other controlled substances to these patients. If you have other questions about anything regarding this process, please ask your ED senior or attending for assistance.
PROCEDURES
Procedures are common in the emergency department. If you are interested in performing procedures, please let your EM senior and attending know so that we can advocate for you to complete the procedure. We understand that not all of our rotators are in procedural specialties, so if you have a patient that needs a procedure but you are not comfortable performing it, please discuss with your attending and EM senior resident.
Typically, procedures on critically ill patients (intubations, central line insertions, arterial line insertions, transvenous pacing, pericardiocentesis, cricothyrotomy, etc) are performed by the emergency medicine residents. There are still many procedures appropriate for all of our learners, including laceration repairs, joint aspirations, lumbar punctures, thoracentesis, and paracentesis. If you are working on the trauma side at HMC there are specific rules surrounding chest tubes. Talk with your trauma team about these rules when you have your first shift.
If your patient needs a procedure, communicate this with your attending. They will help you with the procedure and should be present for the entirety of the procedure. It is important that your attending is aware of any and all procedures and that you have obtained appropriate consent from your patient. If you have never done the indicated procedure before, please review an instructional video prior to the procedure. We recommend the NEJM videos (they do not have a website with a video bank, but you can simply google NEJM + the name of the procedure to easily find this resource).